Treatments for Alzheimer's and Cognitive Disorders

Treatments for Alzheimer’s disease and other cognitive disorders can differ depending on a patient’s particular diagnosis and treatment needs.

Drugs

Cholinesterase Inhibitors

The following drugs in the cholinesterase inhibitor class are used for mild, moderate, and severe Alzheimer’s disease:

Donepezil (Aricept®)

Galantamine (Razadyne®)

Rivastigmine (Exelon®)

They are taken once or twice a day and are available as a pill, a liquid solution, or a patch.

It might take some time to tell whether these drugs are working. Sometimes patients improve; sometimes their condition stabilizes for a while. In either case, evidence suggests that patients with Alzheimer’s do better overall when given medication. The side effects of cholinesterase inhibitors primarily involve the stomach and are usually mild. Most people have no trouble tolerating these drugs.

Cholinesterase inhibitors are also approved by the Food and Drug Administration for Parkinson’s disease dementia (also known as Lewy body disease). In addition, doctors sometimes use them to treat other kinds of dementia and mild cognitive impairment.

NMDA antagonists

Memantine (Namenda®) is the only drug in this category. It works against Alzheimer’s in a different way than the cholinesterase inhibitors. Memantine is approved for use in moderate to severe Alzheimer’s and is often combined with one of the cholinesterase inhibitor drugs. It has few significant side effects. Memantine is taken twice a day and is only available as a pill.

Antidepressants

Some patients with dementia, mild cognitive impairment, and related disorders suffer depression. The depression can be a direct result of the brain disease or a reaction to it. In either case, medication can be helpful. The antidepressant drug may have little effect on patients’ memory problems, but it can significantly improve their mood. Many antidepressants are on the market, and the doctor can usually find one that meets a patient’s needs without causing side effects.

Antipsychotics

A small percentage of patients with dementia has delusions, hallucinations, or agitated behavior. If these troubling symptoms do not respond to other measures or are very severe, drugs called antipsychotics
can be used to control them. When administered in small doses, and for fixed periods of time, antipsychotics usually do not have serious side effects.

Stimulants

Stimulant drugs can be used to improve motivation and thinking speed in some patients with cognitive disorders.

Vitamins and Supplements

Patients with dementia, mild cognitive impairment, and related disorders should have a nutritious diet that includes adequate intake of vitamins.

There is no conclusive evidence that taking large amounts of vitamins or supplements can improve memory in Alzheimer’s disease and other conditions.

Psychotherapy and Counseling

Psychotherapy focusing on how a patient is adjusting to having problems with memory and thinking due to brain disease can be very helpful. Counseling is also recommended for the caregivers and family members of people with Alzheimer’s disease and other dementias.

Cognitive Rehabilitation

In cognitive rehabilitation, a person is trained how to use new strategies to compensate for deficits in memory and thinking. It is particularly useful after brain injuries. At some institutions, research is being done to see if people with Alzheimer’s disease and dementia can be taught to improve or maintain their memories.

Physical Rehabilitation

Many of the conditions that cause memory and cognitive impairment also cause physical symptoms. These include:

trouble walking

loss of balance

weakness

Such symptoms can often be helped by various forms of physical rehabilitation.